Attentional Control Theory (ACT) (Eysenck & Derakshan, 2011) proposes that attention control (AC) deficits are central to the development of anxiety. This meta-analysis investigated the size and ...nature of AC deficits in anxious compared to non-anxious participants. We made the following hypotheses based on ACT: i) anxiety-related AC deficits occur in the AC components of inhibition and switching, but not updating; ii) deficits will be more pronounced for AC efficiency (reaction times) than effectiveness (accuracy); iii) studies with high cognitive load conditions will observe greater deficits than studies with normal cognitive load; iv) age and anxiety level will moderate the effect of anxiety on AC. Fifty-eight studies (N = 8292) met inclusion criteria. The meta-analysis revealed a significant AC deficit for high compared to low anxiety participants (Hedges' g = −0.58). Overall, results supported assumptions of ACT: anxiety produced significant deficits in AC efficiency but not effectiveness; these deficits occurred in inhibition and switching but not updating and studies with high cognitive load conditions found larger anxiety related AC deficits. Age moderated the relationship between anxiety and AC in behavioural studies and anxiety severity moderated this relationship in self-report studies. Theoretical implications of the results are discussed, and future directions for research are proposed.
This meta-analysis has been registered with PROSPERO in 2016, Registration number: CRD42016036927.
•A significant negative relationship between anxiety and Attentional Control was found•Anxiety related deficits found in Attentional Control efficiency but not effectiveness•Inhibition and switching but not updating was negatively impacted by anxiety•The negative relationship between anxiety and Attentional Control increased with age on behavioural measures•Findings largely supported Attentional Control Theory
Abstract Background Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the ...relationship between multimorbidity and depression. Method A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analyzed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity. Results Forty articles were identified as eligible (n=381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity RR: 2.13 (95% CI 1.62 to 2.80) p <.001 and three times greater for people with multimorbidity compared to those without any chronic physical condition RR: 2.97 (95% CI 2.06 to 4.27) p <.001. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition OR: 1.45 (95% CI 1.28 to 1.64) p <.001. A significant but weak association was found between the number of chronic conditions and depressive symptoms r = 0.26 (95% CI 0.18 to 0.33) p <.001. Limitations Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures. Conclusions Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.
Anxiety is common in the context of cancer, but there are few theoretical models that apply to people with cancer across the trajectory of their illness. The aims of this review are to identify ...existing theories and to propose an integrated model of cancer-related anxiety. Using a systematic literature search of Medline, Premedline and PsycINFO databases, we identified nine theoretical models of anxiety in the context of cancer. We reviewed these for psychological concepts that fell under five themes: pre-existing schema, the inherent nature of cancer, cognitive factors, coping responses and contextual factors. From these themes, we integrated concepts from different models to develop a theoretical framework to explain the development and maintenance of anxiety in the context of cancer. The resulting model suggests that pre-existing schema, past experiences of cancer, an intolerance of uncertainty and meta-cognitive beliefs about worry interact with the inherent nature of cancer to produce overwhelming distress. The distress activates cognitive processes characterized by vigilance, worry and rumination. Attempts to cope by re-establishing control, and a pattern of vigilance to cancer-related cues and/or avoidance reinforce anxiety, in the context of a range of systemic factors that can either buffer against or worsen the anxiety.
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•Theoretical models of cancer-anxiety have mainly considered Fear of Recurrence.•Minimal attention has been given to mortality awareness in models of cancer-anxiety.•The cancer context often involves ongoing threat, uncertainty and lack of control.•A model of cancer-related anxiety relevant to all cancer stages is proposed.•The integrated model includes pre-existing, cognitive, coping and contextual factors.
PURPOSE
Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available ...psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis.
METHODS
We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514).
RESULTS
A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention ( g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up ( g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs ( g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR.
CONCLUSION
Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.
•Successful blinding is an important feature of double-blind randomized controlled trials, and ensures that the safety and efficacy of treatments are accurately appraised.•In a range of fields (e.g. ...chronic pain, general medicine), few trials report assessing the success of blinding.•We do not know the frequency or success of blinding assessment among antidepressant RCTs within depression.•Only 4.7% of RCTs examining antidepressants in depression assess blinding.•Overall, blinding is not successful among either patients or investigators.
Successful blinding in double-blind RCTs is crucial for minimizing bias, however studies rarely report information about blinding. Among RCTs for depression, the rates of testing and success of blinding is unknown. We conducted a systematic review and meta-analysis of the rates of testing, predictors, and success of blinding in RCTs of antidepressants for depression. Following systematic search, further information about blinding assessment was requested from corresponding authors of the included studies. We reported the frequency of blinding assessment across all RCTs, and conducted logistic regression analyses to assess predictors of blinding reporting. Participant and/or investigator guesses about treatment allocation were used to calculate Bang's Blinding Index (BI). The BI between RCT arms was compared using meta-analysis. Across the 295 included trials, only 4.7% of studies assessed blinding. Pharmaceutical company sponsorship predicted blinding assessment; unsponsored trials were more likely to assess blinding. Meta-analysis suggested that blinding was unsuccessful among participants and investigators. Results suggest that blinding is rarely assessed, and often fails, among RCTs of antidepressants. This is concerning considering controversy around the efficacy of antidepressant medication. Blinding should be routinely assessed and reported in RCTs of antidepressants, and trial outcomes should be considered in light of blinding success or failure.
To test the effectiveness of an interactive online intervention to improve gluten free diet adherence in adults with celiac disease.
A Randomized controlled trial was conducted. A total of 189 adults ...with biopsy-confirmed celiac disease were recruited and randomized to receive the intervention (n=101) or to a waitlist control condition (n=88). Post-intervention data was available for 70 intervention and 64 waitlist participants. Three month follow-up data was obtained for 46/50 completers from the intervention group. The primary outcome measure was gluten-free diet adherence. Secondary outcomes were gluten-free diet knowledge, quality of life and psychological symptoms.
Results were based on intention-to-treat analyses. The intervention group evidenced significantly improved gluten-free diet adherence, and gluten-free diet knowledge following the treatment period relative to the waitlist control group. The change in knowledge did not contribute to the change in adherence. These improvements were maintained at 3-month' follow-up.
The online program was effective in improving adherence and represents a promising resource for individuals with celiac disease who are struggling to achieve or maintain adequate gluten free diet adherence.
Abstract
Study Objectives
Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep ...psychoeducation in improving postpartum maternal sleep, and depression.
Methods
A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress.
Results
Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness.
Conclusions
Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms.
Clinical Trial Registration
ACTRN12611000859987
Individuals with chronic pain demonstrate attentional biases (ABs) towards pain-related stimuli. However, the clinical importance of these biases is yet to be determined and a sound theoretical model ...for explaining the role of ABs in the development and maintenance of pain is lacking. Within this article, we (1) systematically review prospective and experimental research exploring ABs and pain outcomes in light of current theoretical models and (2) propose a theoretical framework for understanding AB in pain. Across prospective research, an attentional pattern of vigilance-avoidance was observed. Interventions targeting ABs were less consistent; however, there were promising findings among studies that found attentional training effects, particularly for laboratory research. The proposed Threat Interpretation Model suggests a relationship between threat, interpretation, and stimuli in determining attentional processes, which while tentative generates important testable predictions regarding the role of attention in pain and builds on previous theoretical and empirical work in this area.
Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods ...Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.
Cognitive Bias Modification (CBM) refers to the modification of cognitive biases, such as selectively attending to threatening information or interpreting information in a threatening way. CBM for ...attention (CBM-A) and interpretation (CBM-I) are efficacious in reducing anxiety vulnerability and anxiety symptoms. However, little research has investigated the potential synergies of these interventions. This study aimed to determine the relative efficacy of CBM-A, CBM-I, and combined CBM for reducing social anxiety symptoms and attenuating anxiety vulnerability in response to a social stressor task. Participants (
N
= 116) were randomly allocated to receive CBM-A, CBM-I, combined CBM, or placebo. Results revealed that CBM-I reduced negative interpretation bias and social anxiety symptoms. Furthermore, CBM-I improved speech performance on a social stressor task. However, CBM-A procedures did not modify attentional biases or anxiety vulnerability. These findings support the efficacy of CBM-I for social anxiety; however, no evidence for the efficacy of CBM-A was found, nor was the combined cognitive bias hypothesis supported in this study.
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